Efficacy of Medications for Multiple Sclerosis-Related Fatigue

 Does your competent? doctor know know to administer a fatigue placebo CORRECTLY? You do want your post stroke fatigue cured, right?

Efficacy of Medications for Multiple Sclerosis-Related Fatigue

Among patients with MS-related fatigue, amantadine, fampridine, and methylphenidate improved fatigue-related functioning, but no medication outperformed placebo for fatigue severity.

Amantadine, fampridine, and methylphenidate are associated with improvements in fatigue-related functional burden among patients with multiple sclerosis (MS), although no medication is superior to placebo for reducing fatigue severity, according to a study published in Neurodegenerative Disease Management.

Researchers conducted a systematic review and network meta-analysis to compare the efficacy of pharmacologic treatments for MS-related fatigue. Eligible studies included randomized clinical trials or crossover trials evaluating medications used to treat MS-related fatigue in adults with MS. Outcomes included the Fatigue Severity Scale (FSS), which measures fatigue severity, and the Modified Fatigue Impact Scale (MFIS), which assesses the effects of fatigue on physical, cognitive, and psychosocial functioning.

A total of 15 studies published between 1995 and 2024 were included in the systematic review. Of these, 4 were crossover studies, and the most frequent countries of origin were the United States and Iran. In total, 940 patients in intervention arms and 662 patients in control arms were evaluated. In 4 studies, control groups were not placebo and instead included aspirin, ondansetron, fampridine, and cognitive behavioral therapy (CBT).

 

[T]reatment decisions should be individualized and consider patient-specific factors, including disability level, comorbid depression, sleep disorders, and functional priorities.

For fatigue severity, none of the medications was superior to placebo. Based on P score rankings, N-acetylcysteine (P score, 0.94), modafinil (P score, 0.63), and aspirin (P score, 0.55) ranked above placebo for improving fatigue severity, although standardized mean differences did not reach statistical significance.

For fatigue-related daily functioning measured using the MFIS, amantadine (mean difference [MD], −12.11; 95% CI −14.28 to −9.94), fampridine (MD, −14.05; 95% CI −22.59 to −5.52), and methylphenidate (MD, −5.25; 95% CI −8.44 to −2.06) were associated with statistically significant improvements compared with placebo. However, CBT (MD, 1.40; 95% CI −1.99 to 4.80) and modafinil (MD, 0.60; 95% CI −1.26 to 2.46) did not differ significantly from placebo.

The authors noted that previously proposed minimally important differences for the MFIS suggest that the improvements observed with amantadine and fampridine may be clinically meaningful, whereas the magnitude of benefit associated with methylphenidate did not exceed the suggested threshold despite reaching statistical significance.

Study limitations include the limited number of trials per comparison, clinical heterogeneity,  methodological heterogeneity, and the overall low-to-moderate certainty of evidence.

“[T]reatment decisions should be individualized and consider patient-specific factors, including disability level, comorbid depression, sleep disorders, and functional priorities,” the authors concluded.

This article originally appeared on Neurology Advisor

Acupuncture improves stroke recovery and reshapes brain networks

HOW?

Ask your competent? doctor to explain the mechanism of action since energy meridians have never been proven to exist.

 No mechanism of action is possible except as a placebo or do you believe in hand waving.

Acupuncture improves stroke recovery and reshapes brain networks

A new study published in CNS Neuroscience and Therapeutics highlights the potential benefits of acupuncture in alleviating neurological impairment and improving motor recovery in patients with stroke.

Researchers investigate acupuncture's effects on neuroplasticity

Ischemic stroke is a leading cause of physical disability in adults, often resulting in unilateral motor impairment or hemiplegia, a condition of complete or severe muscle paralysis on one side of the body. Post-stroke hemiplegia significantly affects the overall quality of life of affected individuals and puts heavy economic pressure on the healthcare system and families.

Several clinical studies have revealed abnormal functional connectivity in brain regions involved in vital motor functions in stroke patients, including the sensorimotor, default mode, and cognitive control networks. Studies have also highlighted brain structural alterations in stroke patients, including cortical thinning.

The recovery of motor function in stroke patients is associated with complex structural and functional reorganization of the brain. Recent evidence highlights the potency of acupuncture in improving neurological functions. However, it remains largely unknown whether acupuncture helps restore the brain's structural and functional frameworks in stroke patients.

Given that acupuncture is considered to be a safe, effective, and low-cost complementary treatment for stroke, this randomized controlled trial aimed to explore neural mechanisms by which acupuncture adjusts motor dysfunction in patients with post-stroke hemiplegia.

Researchers track brain changes after treatment

A total of 56 stroke patients were enrolled in the trial. They were randomly allocated in a 2:1 ratio to receive either real acupuncture or sham acupuncture (control group) over a period of two weeks.

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After completion of the intervention period, all patients were assessed for motor impairment and recovery, neurological deficits, and limb motor control. Post-intervention structural and functional changes in the brain were also assessed using Magnetic Resonance Imaging (MRI).

After exclusions related to treatment completion and MRI data quality, 46 patients were included in the final MRI analysis.

Acupuncture improves motor recovery beyond sham

Post-treatment assessments showed that motor function improved in both groups, but patients who received real acupuncture experienced greater gains in limb motor control and overall motor recovery than those in the sham acupuncture group. These clinical improvements were accompanied by measurable changes in brain function and structure.

MRI analyses revealed reduced disjointedness and a trend toward lower flexibility within the default mode network, changes that were associated with better motor outcomes.

Acupuncture was also linked to increased gray matter volume in regions involved in sensorimotor processing and cognitive-motor integration. Importantly, participants who showed larger reductions in default mode network disruption and greater increases in gray matter volume also tended to experience greater improvements in motor impairment and recovery. 

Findings support further rehabilitation research using acupuncture

The findings suggest that acupuncture may support motor recovery after stroke by promoting changes in both brain function and structure. Patients who received real acupuncture showed better motor control and recovery, accompanied by signs of a more stable and less fragmented default mode network, a brain system involved in attention, self-awareness, and other cognitive processes that help guide movement.

The treatment was also associated with increased gray matter volume in regions linked to sensorimotor processing, cognition, and coordination, suggesting broader recovery-related adaptations across the brain. Together, these functional and structural changes may help support the planning and execution of movement following stroke.

The authors caution, however, that MRI-derived changes in gray matter volume are imaging markers of structural adaptation rather than direct evidence of cellular-level neuroplasticity. They also note that some clinical improvement was observed in the sham acupuncture group, potentially reflecting placebo-related effects and the standard pharmacotherapy received by both groups.

In addition, the trial did not demonstrate a statistically significant group-by-time interaction, and the lack of long-term follow-up means it remains unclear whether the observed brain changes translate into lasting functional benefits. Larger studies with extended follow-up will therefore be needed to confirm the findings and clarify the role of acupuncture as a complementary rehabilitation strategy.

Download your PDF copy by clicking here.

Effects of acupuncture on brain tissue metabolism and neurological function in patients with ischemic stroke: a systematic review and meta-analysis

 

Ask your competent? doctor to explain the mechanism of action since energy meridians have never been proven to exist.

 No mechanism of action is possible except as a placebo.

Effects of acupuncture on brain tissue metabolism and neurological function in patients with ischemic stroke: a systematic review and meta-analysis

• 

  Song Li 1,2†

• 

  Mengqi Yue 3†

• X

  Xu Chen 3

• X

  Xiahui Zhang 2

• L

  Lijun Huang 2

• Z

  Ziyi Wang 2

• Y

  Yanling Jin 2

• Q

  Qian Ma 2

• L

  Lei Ma 2*

• J

  Jing Shi 2*

• 1. Heilongjiang University of Chinese Medicine, Harbin, China

• 2. Yunnan Provincial Hospital of Traditional Chinese Medicine, The First Affiliated Hospital of Yunnan University of Chinese Medicine, Kunming, China

Abstract

Objective: 

This study aims to explore the effects of acupuncture on brain tissue metabolism and neurological function in regions centers of patients with ischemic stroke (IS).

Methods: 

From the establishment of the database until May 20, 2025, a comprehensive search was conducted across several databases, including CNKI, WanFang, VIP Database, CBM, PubMed, Cochrane Library, Embase, and Web of Science. This search specifically targeted clinical randomized controlled trials (RCTs) that investigated the effects of acupuncture on cerebral tissue metabolism within the center of IS lesions and its subsequent impact on neurological function. The literature was meticulously screened, and information was extracted in accordance with the PRISMA guidelines. The quality of the literature was assessed using the risk of bias scale recommended in the Cochrane Handbook for Systematic Reviews of Interventions, version 5.1.0. Additionally, the quality of the included literature and the meta-analysis were evaluated using RevMan 5.4.

Results: 

This study included 9 randomized controlled trials involving 602 patients. The meta-analysis results indicate that acupuncture treatment significantly improves the NAA/Cr ratio [MD = 0.19, 95% CI (0.14–0.24), p < 0.00001, 8 studies, 526 subjects] and reduces the Cho/Cr ratio [MD = −0.25, 95% CI (−0.36, −0.15), p < 0.00001]. However, no significant difference was observed in reducing the Lac/Cr ratio [MD = 0.04, 95% CI (−0.24, 0.32), p = 0.79]. Additionally, acupuncture treatment led to significant improvements in the NIHSS score [MD = −2.84, 95% CI (−3.76, −1.92), p < 0.00001], the FMA score [MD = 12.94, 95% CI (7.07, 18.81), p < 0.0001], and the MoCA score [MD = 3.20, 95% CI (2.30–4.10), p < 0.00001, 2 studies, 120 subjects] compared to non-acupuncture treatment. Overall, acupuncture demonstrated superior efficacy in improving the NAA/Cr, and Cho/Cr ratios, as well as the FMA, MoCA, and NIHSS scores, among IS patients.

Conclusion: 

Adding acupuncture therapy to conventional treatment improves brain tissue metabolism and neurological function in patients with IS. It shows better efficacy compared to conventional treatment alone. However, evidence for specific outcome measures is limited. High-quality, large-scale RCTs are needed to strengthen the evidence base.

Systematic review registration: 

https://www.crd.york.ac.uk/, CRD42024579263.

Acupuncture Anti-Inflammatory Effects on Post-Stroke Depression

Ask your competent? doctor to explain the mechanism of action since energy meridians have never been proven to exist.

 No mechanism of action is possible except as a placebo.

Acupuncture Anti-Inflammatory Effects on Post-Stroke Depression

 

A randomized clinical trial from clinicians affiliated with Nanjing University of Chinese Medicine reports that a six-week course of acupuncture produced clinically meaningful reductions in post-stroke depression severity comparable to escitalopram, while also shifting serum inflammatory markers in an anti-inflammatory direction, including lower IL-1β, IL-6, TNF-α, and IFN-γ and higher IL-10. At follow-up four weeks after treatment ended, the electroacupuncture (EA) group maintained lower depression scores than the escitalopram group, suggesting a short-term durability advantage after discontinuation of therapy. [1]

The study enrolled 150 adults aged 20–70 years with ischemic stroke confirmed by CT or MRI and mild-to-moderate post-stroke depression defined by a Hamilton Depression Scale–17 item (HAMD-17) score between 8 and 24. Participants were randomized to electroacupuncture with oral placebo or to escitalopram with sham electroacupuncture. Seventy-two participants in the EA arm and seventy-one in the escitalopram arm completed the protocol. Both groups continued standard secondary stroke prevention medications and rehabilitation programs, but acupuncture was not otherwise incorporated into routine rehabilitation care.

Clinical outcomes included clinician-rated and self-rated depression scales. In the electroacupuncture group, mean HAMD-17 scores decreased from 18.88 at baseline to 13.75 at week 6 and to 10.47 at the four-week post-treatment follow-up. In the escitalopram group, HAMD-17 scores decreased from 18.52 at baseline to 12.92 at week 6 and to 12.10 at follow-up. Self-rated depression assessed using the Zung Self-Rating Depression Scale (SDS) showed similar changes. EA reduced SDS scores from 62.06 at baseline to 48.18 at week 6 and 42.47 at follow-up, while escitalopram reduced SDS scores from 62.93 to 46.79 and 44.35 over the same time points.

Functional outcomes were assessed using the Modified Barthel Index (MBI), a scale measuring independence in activities of daily living. In the EA group, MBI scores increased from 58.54 at baseline to 69.44 at week 6 and 73.64 at follow-up. The escitalopram group improved from 59.82 to 70.44 and 74.87 over the same period. These functional improvements occurred alongside reductions in depressive symptoms in both treatment arms.

The electroacupuncture protocol was narrowly defined and fully reproducible. Four acupuncture points were used: GV20 (Baihui), GV29 (Yintang), LV3 (Taichong), and LI4 (Hegu), with LV3 and LI4 needled bilaterally. Electrical stimulation was applied between GV20 and Yintang and between ipsilateral LV3 and LI4. Patients were treated in the supine position after skin disinfection with iodophor.

Needle specifications and insertion techniques were explicitly reported. GV20 was needled using a 0.30 mm × 25 mm sterile disposable needle inserted at a 45-degree angle to a depth of approximately 15–20 mm. Yintang was needled with a 0.30 mm × 25 mm needle directed downward at a 15-degree angle to a depth of approximately 10–15 mm. LV3 and LI4 were needled perpendicularly using 0.30 mm × 40 mm needles to a depth of approximately 25–30 mm. Manual manipulation consisting of lifting, thrusting, and twirling was applied until deqi sensations were elicited.

Electrical stimulation was delivered using an electronic acupuncture apparatus. A alternating frequency of 2/15 Hz was used, with intensity adjusted to patient tolerance. Each session lasted 30 minutes and treatments were administered once daily, five days per week, for six consecutive weeks, totaling 30 sessions. All treatments were performed by a licensed acupuncture physician with more than ten years of clinical experience.

The escitalopram group received oral escitalopram at a dose of 10–20 mg daily for 40 days and concurrent sham electroacupuncture. Sham needling used 0.30 mm × 15 mm needles inserted superficially to a depth of 3–5 mm at sites located 0.5–1.0 cm away from the true acupuncture points. Electrodes were attached, but electrical output was set to zero. [1]

Objective biological outcomes focused on inflammatory cytokines. Fasting venous blood samples were collected at baseline and within 48 hours after completion of the six-week intervention. Serum IL-1β, IL-6, IL-10, TNF-α, and IFN-γ levels were measured using immunofluorescence on a BD FACSCanto II flow cytometer. In the electroacupuncture group, IL-1β decreased from 10.59 to 5.62 pg/mL, IL-6 decreased from 36.21 to 23.16 pg/mL, TNF-α decreased from 12.94 to 7.37 pg/mL, and IFN-γ decreased from 15.52 to 10.11 pg/mL. IL-10 increased from 10.12 to 17.22 pg/mL. These are beneficial effects since the aforementioned cytokines are pro-inflammatory with the exception of of IL-10, which is anti-inflammatory. [1]

Comparable cytokine shifts were observed in the escitalopram group, with IL-1β decreasing from 10.99 to 6.14 pg/mL, IL-6 decreasing from 36.57 to 22.13 pg/mL, TNF-α decreasing from 12.93 to 7.49 pg/mL, IFN-γ decreasing from 16.06 to 10.58 pg/mL, and IL-10 increasing from 9.49 to 16.75 pg/mL.

Adverse events were mild and self-limited. In the electroacupuncture group, four participants experienced localized pain or hematoma at needle sites. In the escitalopram group, dizziness and drowsiness were reported, and several participants experienced short-lived discontinuation symptoms lasting less than 48 hours. No serious adverse events occurred.

This trial demonstrates that a focused acupuncture protocol delivered at high frequency can reduce depressive symptoms after ischemic stroke while producing measurable reductions in proinflammatory cytokines. For licensed acupuncturists, the study provides a clearly defined point prescription, needle specifications, stimulation parameters, and treatment frequency associated with both clinical and biological effects in post-stroke depression. [1]

Reference:

1. Ma, Feixiang, Guiping Cao, Lu Lu, Yingling Zhu, Wanlang Li, and Li Chen. “Electroacupuncture versus Escitalopram for Mild to Moderate Post-Stroke Depression: A Randomized Non-Inferiority Trial.” Frontiers in Psychiatry 15 (2024): Article 1332107.

International Trial Finds Perispinal Etanercept No More Effective Than Placebo for Stroke Recovery

 Finally proof on this. Here's all the previous unproven writeups on this and the stuff from Dr. Tobinick's unproven uses.

You'll want to read all of the previous posts on Etanercept for other uses and risks and the previous unproven uses. Unless you really think your doctor has a good handle on this.

etanercept (40 posts to February 2011)

dr. Tobinick (32 posts to November 2012)

 

International Trial Finds Perispinal Etanercept No More Effective Than Placebo for Stroke Recovery

A recent international clinical trial has determined that “perispinal” etanercept, an unproven treatment for stroke recovery, is no more effective than a placebo. The study, which marks the first global evaluation of this therapy, found the treatment to be harmless but concluded it offered no significant benefits over an inactive dummy drug.

The trial involved injecting etanercept into the spinal area of participants and comparing its effects to those of a placebo. Researchers reported no measurable improvement in outcomes among patients who received the treatment compared to those given the placebo. Despite being available in the United States as a potential option for stroke recovery, the findings suggest that perispinal etanercept does not provide any added therapeutic advantage. The study’s results contribute to ongoing discussions about evidence-based treatments for stroke rehabilitation.

Therapeutic efficacy of acupuncture on motor dysfunction in ischemic stroke patients with hemiplegia and its EEG characteristics: protocol for a randomized, sham-acupuncture controlled, assessor-and-statistician-blinded trial

Ask your competent? doctor to explain the mechanism of action since energy meridians have never been proven to exist.

 No mechanism of action is possible except as a placebo.

Therapeutic efficacy of acupuncture on motor dysfunction in ischemic stroke patients with hemiplegia and its EEG characteristics: protocol for a randomized, sham-acupuncture controlled, assessor-and-statistician-blinded trial

Yue-Hua  GuYue-Hua GuJun-Xian  ChenJun-Xian ChenCui-Na  YanCui-Na YanLi-Wei  WangLi-Wei WangYi-Ling  MiuYi-Ling MiuJian-Xiang  LiJian-Xiang LiYi- Yun  GuYi- Yun GuJie  XuJie XuMing  XiaMing XiaXiao-Jing  ZhangXiao-Jing ZhangLu  YuLu Yu*

Background: 

Stroke is the second leading cause of death in the world, with high disability rate in survivors, among which ischemic stroke accounts for over 80% of the total. Limb dysfunction is a common neurological deficit symptom left by ischemic stroke. Timely rehabilitation therapy in the early recovery stage of stroke is important for neurological function improvement. Acupuncture therapy for "simultaneous treatment of phlegm and blood stasis", selecting acupoints based on pathogenic characteristics of ischemic stroke, has been applied to treat stroke patients with hemiplegia in our center, and it has exhibited significant effects. However, high-quality clinical evidence of this acupuncture strategy is still lacking. Therefore, the present study aims to evaluate the efficacy and safety of acupuncture therapy in improving limb function of patients with recovery-stage ischemic stroke. 

Methods: 

This study will be a single-center, randomized, assessor-and-statistician-blinded, sham acupuncture-controlled clinical trial. After informed consent signing, 70 eligible patients with limb dysfunction in post-stroke recovery stage will be randomized into the treatment group or sham acupuncture group in a 1:1 ratio. The treatment course will last for 2 weeks, and the scale evaluation and EEG examination will be conducted before and after treatment. The primary outcome is the changes of limb function pre and post treatment using the modified Fugl-Meyer scale. Secondary outcomes include score changes in Berg Balance Scale, Fugl-Meyer Assessment Sensory Function Scale, Modified Ashworth Score, Barthel Index and TCM syndrome score pre and post treatment. Additionally, we will employ EEG to evaluate regulation effects of acupuncture on cortical neuronal excitability and functional connectivity across brain regions in stroke patients, and screen EEG-based biomarkers with predictive value. 

Discussion: 

This study aims to evaluate the efficacy and safety of acupuncture therapy in stroke patients with hemiplegia, and to explore electrophysiological mechanisms of the therapeutic effects. The study will provide high-quality clinical evidence for the application of acupuncture therapy with acupoint combination based on the TCM theory in neurological rehabilitation for ischemic stroke. Trial registration: This study protocol has been registered at itmctr.ccebtcm.org.cn (Registration No. ITMCTR2025001171)

Acupuncture versus rehabilitation for post-stroke shoulder-hand syndrome: a systematic review and meta-analysis of randomized controlled trials

 

Impossible for acupuncture to have effects except as a placebo. Energy meridians have never been proven to exist.

Acupuncture versus rehabilitation for post-stroke shoulder-hand syndrome: a systematic review and meta-analysis of randomized controlled trials

Jinyuan Shi^1,2†Fuyan Chen^1,2*†‡Yang Liu^1,2†Mingtong Bian^1,2Xiaowei Sun^1,2Ru Rong^1,2Shuo Liu^1,2

• ¹Department of Acupuncture, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
• ²National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China

Background: Shoulder-hand syndrome (SHS) is one of the common sequelae after stroke, which not only hinders the recovery of patients, but also increases the economic burden of the family. In the absence of effective treatment measures, acupuncture treatment has been widely used in China to treat post-stroke shoulder-hand syndrome, but the details are unclear. Therefore, this review aims to evaluate the true efficacy of acupuncture in patients with SHS.

Methods: We searched eight databases [PubMed, Embase, Web of Science, Cochrane library, China Biomedical Literature Database (CBM), China Science and Technology Journal (VIP) database, the China National Knowledge Infrastructure (CNKI) database, and Wan fang database] from its inception to March 2025, randomized controlled trials (RCTs) of SHS acupuncture treatment combined with rehabilitation (Rehab). Two investigators independently used pre-designed forms to extract valid data from eligible randomized controlled trials. Meta-analysis was implemented through the Rev. Man software (version 5.4). The strength of the evidence obtained was implemented using the GRADE profiler software. Adverse events (AEs) were collected by reading the full text and used to evaluate the safety of acupuncture treatment.

Results: Forty-seven studies, involving 4,129 participants, met the eligibility criteria, and were included in the review. Overall meta-analysis showed that combined acupuncture rehabilitation significantly improved motor function (upper-limb Fugl-Meyer Assessment (FMA): 41 studies, mean difference (MD) 9.50, 95% confidence interval (CI) [8.47, 10.53]) and pain reduction (visual analog score (VAS): 37 studies, MD: −1.49, 95% CI [−1.66, −1.33]). It also improved activities of daily living (ADL) compared to rehabilitation alone (ADL: 17 studies, MD: 11.94, 95% CI [8.26, 13.63]). There was no significant difference in the occurrence of adverse events (AEs) between acupuncture treatment combined with Rehab and Rehab alone (p > 0.05). The certainty of the evidence was rated low level because of flaws in the study design and considerable heterogeneity among the included studies.

Conclusion: This review found that acupuncture treatment combined with Rehab treatment may have a positive promoting effect on improving motor function, reducing pain, and improving daily living ability in SHS patients. However, due to the existing methodological quality issues, our findings should be treated with caution. Future high-quality studies are urgently needed to validate our findings.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD42024536169.

1 Introduction

Stroke is the second largest cause of death worldwide and the first leading cause of acquired long-term disability, leading to an annual global economic burden (1). Post-stroke shoulder hand syndrome (PS-SHS), also known as post-stroke complex regional pain syndrome, is experienced by more than 50% of stroke patients (2), it usually occurs between 2 and 3 months of an acute event and usually presents with pain, hyperalgesia, joint swelling, and limited range of motion (3). Post-stroke shoulder hand syndrome is difficult to treat, and its symptoms may persist for a long time, resulting in limited upper limb function or even irreversible permanent apraxia (4, 5). In addition, SHS may hinder the overall recovery, prolong hospitalization, limit the patients’ activities of daily living (ADL), reduce the quality of life, and bring heavy economic burden on the patients and their families (6). Currently, commonly used treatments for post-stroke SHS include drug therapy, soaking in cold water, physical therapy (PT), occupational therapy (OT), psychotherapy, and sympathetic block (7, 8). Although these conventional treatments were initially found to be effective, their adverse effects cannot be ignored. Low-dose oral steroids are effective in improving the SHS after stroke (9), for example, to avoid adverse effects associated with long-term drug use, steroids are only indicated for short-term treatment and are considered a difficult factor for long-term post-stroke SHS (5), early referral to PT, OT, and psychotherapy may prevent the progression of symptoms (10). However, the disadvantages of these approaches, such as high healthcare costs, increased workforce investment, and increased demands for patient collaboration, have also received attention. In addition, the expertise of rehabilitation therapists varies from different regions, which will affect the treatment effect. The incidence of SHS after stroke remains high and is a challenging problem to be addressed. To date, consistently effective and good patient compliance methods are still lacking (11).

As a basic therapy for the prevention and treatment of traditional Chinese medicine (TCM), acupuncture has been used in clinical practice in China for thousands of years (12). According to the site of application, acupuncture can be divided into abdominal acupuncture (AA) and scalp acupuncture (SA). In addition, according to the surgical method, acupuncture can be divided into manual needle (MA), electro-acupuncture (EA), and warm acupuncture (WA) has been proved to have the advantages of low price, good effect and simple operation (13). Moreover, as a non-pharmacological intervention, acupuncture has better efficacy on chronic diseases difficult to treat with traditional treatment methods, such as low back pain and renal disease (14, 15). As a result of these advantages, acupuncture has received continued interest from the general public and health professionals (16). Furthermore, more medical institutions are using acupuncture clinically and show that acupuncture can be used as a prospective therapeutic measure to improve motor function in patients with SHS (6, 17).

In the last few years, three reviews have been published on acupuncture for SHS. The meta-analysis published in 2018 (18) only evaluated the effect of manual acupuncture on the treatment efficacy in patients with SHS, and manual acupuncture represented only one acupuncture form, and the findings were necessarily limited. The meta-analysis published in 2019 (19) included only 13 studies totaling 1,040 patients, an insufficient sample size, and only evaluated the effect of electroacupuncture effects in SHS patients, and the findings were limited. The meta-analysis, published in 2019 (20), selected FMA, VAS and ADL as outcome measures. The results showed that acupuncture treatment had excellent efficacy in relieving the symptoms of SHS. However, the intervention did not involve warm acupuncture. Therefore, we conducted a systematic review of the latest evidence on acupuncture (including warm acupuncture) as an add-on treatment for the clinical treatment of post-stroke SHS. Furthermore, with the widespread use of acupuncture treatment, more research is published in recent years (17, 21). Therefore, the aim of this review was to explore the effect of acupuncture treatment on the relief of clinical symptoms in patients with SHS and to update previous published reviews.